Apparatus and method for orthopedic fixation

ABSTRACT

A filament retaining washer for mounting about the shank of a bone screw deployed in a bone whereby to retain the filament to the bone, the filament retaining washer comprising a structure having a screw hole extending therethrough for receiving therein the shank of the bone screw deployed in the bone, whereby to secure the structure to the bone, the screw hole defining a first axis, and the structure having a filament hole extending therethrough for receiving a filament therein so as to retain the filament to the structure, the filament hole defining a second axis extending substantially perpendicular to the first axis.

FIELD OF THE INVENTION

[0001] This invention relates to surgical apparatus and methods ingeneral, and more particularly to surgical apparatus and methods forfixing bone and soft tissue in place during trauma and reconstructivesurgery.

BACKGROUND OF THE INVENTION

[0002] Bone fixation, sometimes also referred to as fracture fixation,is an established art. Fixation screws, and fixation screws incombination with metal plates, are widely used in the art to stabilizebone so as to facilitate healing.

[0003] Surgical cables, and surgical cables in combination with metalplates, are also well known in the bone fixation art. Cables, and cablesin combination with plates, are generally used in situations where theuse of screws, or screws in combination with plates, is not suitable. Byway of example, cables, and cables in combination with plates, arefrequently used in the fixation of long oblique fractures resulting fromhigh energy trauma such as a motor vehicle accident. By way of furtherexample, screw fixation is frequently not adequate for fractures thatare highly comminuted, and fixation with cables, or cables incombination with plates, is required.

[0004] Cables are also sometimes used in conjunction with screws, and inconjunction with screws in combination with plates. By way of example,cables may be used in conjunction with screws, and screws in combinationwith plates, where a screw strips its threads in deployment, or wherescrews, or screws in combination with plates, is deemed insufficient forthe fixation at hand.

[0005] With cable fixation, it is customary to encircle the subject bonewith the body of the cable, and then to secure the two free ends of thecable together with a deformable crimp so as to effect fixation.

[0006] In general, cable fixation on the shaft of a so-called “longbone” does not present a significant problem with migration, inasmuch asthis portion of the bone is substantially tubular in geometry. However,the ends of these long bones typically have a significant flare in theirgeometry. As a result, tightening of the encircling cable often causesthe cable (and crimp) to migrate toward the narrower section of thebone. Such migration can displace the cable sufficiently far from itsintended location as to significantly loosen, or render ineffective,encirclement of the bone segments.

[0007] Thus, there is a need for an improved apparatus and method whichwill permit bone fixation to be effected with screws and cable.

[0008] There further exists a need for an improved apparatus and methodfor effecting bone fixation with cable, such that the cable will notslide along the bone during tightening of the cable.

[0009] In addition to the foregoing, in many situations, soft tissue mayneed to be attached to bone. By way of example, a ligament may need tobe attached to bone during trauma and reconstructive surgery. In some ofthese situations, bone fixation may also be necessary, and such bonefixation may involve the use of screws, cables and plates, either aloneor in combination with one another.

[0010] Thus, there is a need for an improved apparatus and method forattaching soft tissue to bone.

[0011] There further exists a need for an improved apparatus and methodfor attaching soft tissue to bone, where screws may be used to helpeffect fixation to bone.

SUMMARY OF THE INVENTION

[0012] Accordingly, one object of the present invention is to provideimproved apparatus for use in bone fixation.

[0013] Another object of the present invention is to provide improvedapparatus for use in bone fixation which involves the use of bonescrews, metal plates and/or cables.

[0014] Still another object of the present invention is to provide animproved method for bone fixation.

[0015] Yet another object of the present invention is to provideimproved apparatus for attaching soft tissue to bone.

[0016] And another object of the present invention is to provideimproved apparatus for attaching soft tissue to bone, where screws maybe used to help effect fixation to bone.

[0017] A further object of the present invention is to provide animproved method for attaching soft tissue to bone.

[0018] These and other objects of the present invention are addressed bythe provision and use of a novel filament retaining washer for mountingabout the shank of a bone screw deployed in a bone whereby to retain thefilament to the bone, the filament retaining washer comprising astructure having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the structure to the bone, the screw hole defining a first axis,and the structure having a filament hole extending therethrough forreceiving a filament therein so as to retain the filament to thestructure, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis.

[0019] In another form of the invention, there is provided a filamentretaining washer for mounting about the shank of a bone screw deployedin a bone whereby to retain the filament to the bone, the filamentretaining washer comprising a body; a downwardly projecting extensionconnected to the body and having a screw hole extending therethrough forreceiving therein the shank of the bone screw deployed in the bone,whereby to secure the downwardly projecting extension to the bone, thescrew hole defining a first axis; and an upwardly projecting extensionconnected to the body and having a filament hole extending therethroughfor receiving a filament therein so as to retain the filament to theupwardly projecting extension, the filament hole defining a second axisextending substantially perpendicular to the first axis.

[0020] And in another form of the invention, there is provided a systemfor securing an object to a bone, the system comprising a bone screw; awasher comprising a body, a downwardly projecting extension connected tothe body and having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis, and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough, forreceiving a filament therein so as to retain the filament to theupwardly projecting extension, the filament hole defining a second axisextending substantially perpendicular to the first axis; and a filamentreceived by the filament hole, the filament securing the object to thebone.

[0021] In another form of the invention, there is provided a method forsecuring an object to a bone, the method comprising providing a screw, afilament and a suture retaining washer, the suture retaining washercomprising a body, a downwardly projecting extension connected to thebody and having a screw hole extending therethrough for receivingtherein the shank of a bone screw deployed in the bone, whereby tosecure the downwardly projecting extension to the bone, the screw holedefining a first axis, and an upwardly projecting extension connected tothe body and having a filament hole extending therethrough for receivinga filament therein so as to retain the filament to the upwardlyprojecting extension, the filament hole defining a second axis extendingsubstantially perpendicular to the first axis; securing the washer tothe bone with the screw, with the filament extending through thefilament hole; and using the filament to secure the object to the bone.

[0022] And in another form of the invention, there is provided a methodfor securing an object to a bone, the method comprising providing ascrew, a filament and a suture retaining washer, the suture retainingwasher comprising a structure having a screw hole extending therethroughfor receiving therein the shank of the bone screw deployed in the bone,whereby to secure the structure to the bone, the screw hole defining afirst axis, and the structure having a filament hole extendingtherethrough for receiving a filament therein so as to retain thefilament to the structure, the filament hole defining a second axisextending substantially perpendicular to the first axis; securing thewasher to the bone with the screw, with the filament extending throughthe filament hole; and using the filament to secure the object to thebone.

[0023] The above and other features of the invention, including variousnovel details of construction and combinations of parts, will now bemore particularly described with reference to the accompanying drawingsand pointed out in the claims. It will be understood that the particulardevices, assembly and method embodying the invention are shown by way ofillustration only and not as limitations of the invention. Theprinciples and features of this invention may be employed in various andnumerous embodiments without departing from the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

[0024] These and other objects and features of the present inventionwill be more fully disclosed or rendered obvious by the followingdetailed description of the preferred embodiments of the invention,which is to be considered together with the accompanying drawingswherein like numbers refer to like parts, and further wherein:

[0025]FIG. 1 is a perspective view showing a novel surgical fasteningsystem securing together two bone segments;

[0026]FIG. 2 is perspective view of a cable retaining washer which formspart of the surgical fastening system shown in FIG. 1;

[0027]FIG. 3 is an exploded side view, in section, of a bone screw,cable retaining washer and bone plate which form part of the surgicalfastening system shown in FIG. 1;

[0028]FIG. 4 is a perspective view of an alternate form of cableretaining washer formed in accordance with the present invention;

[0029]FIG. 5 is a perspective view of another alternative form of cableretaining washer formed in accordance with the present invention;

[0030]FIG. 6 is a perspective view of still another alternative form ofcable retaining washer formed in accordance with the present invention;

[0031]FIG. 7 is a perspective view of yet another alternative form ofcable retaining washer formed in accordance with the present invention;

[0032]FIG. 8 is a perspective view of a bone screw, cable retainingwasher and bone plate which comprise another embodiment of the presentinvention;

[0033]FIG. 9 is a side view, in section, of the apparatus shown in FIG.8;

[0034]FIG. 10 is a side view, partially in section, showing a bone screwsecuring the cable retaining washer of FIG. 2 directly to a bone;

[0035]FIG. 11 is a perspective view showing an alternative form ofsurgical fastening system formed in accordance with the presentinvention;

[0036]FIG. 12 is a perspective view of a suture retaining washer whichforms part of the surgical fastening system shown in FIG. 11;

[0037]FIG. 13 is a partial sectional view of a bone screw and sutureretaining washer which form part of the surgical fastening system shownin FIG. 11;

[0038]FIG. 14 is a perspective view showing a suture loop attaching apiece of surgical mesh to a suture retaining washer; and

[0039]FIG. 15 is a view similar to that of FIG. 11, except showing theassembly of FIG. 14 secured to a bone.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0040] Looking first at FIGS. 1-3, there is shown a surgical fasteningsystem 5 which comprises one preferred form of the invention.

[0041] Surgical fastening system 5 generally comprises a bone plate 6, aplurality of bone screws 9, a plurality of cable retaining washers 12,and a plurality of cable loops 15. As used herein, the term “cable” isintended to encompass braided cable, wire and the like.

[0042] Bone plate 6 is deployed so that the bone plate extends acrossthe fracture line 18 of two bone segments 20, 21. The heads 25 (FIG. 3)of bone screws 9 engage cable retaining washers 12, while the shanks 27of bone screws 9 extend through screw holes 30 in cable retainingwashers 12, through screw holes 33 in bone plate 6 and into bonesegments 20, 21, whereby to secure bone plate 6 to bone segments 20, 21and, the in process, to secure bone segments 20, 21 together.Additionally, cable loops 15 encircle bone segments 20, 21 and aresecured to cable retaining washers 12, whereby cable loops 15 furthersecure bone segments 20, 21 to bone plate 6 and, as a result, to oneanother.

[0043] Bone plate 6 is of the sort well known in the art. By way ofexample but not limitation, bone plate 6 generally comprises anelongated body 35 penetrated by the aforementioned screw holes 33. Thebone plate's top surface 36 generally includes recesses 40 about the topends of screw holes 33; in conventional bone plate applications,recesses 40 receive the semi-spherical undersides of the heads 25 ofbone screws 9.

[0044] Bone screws 9 are also of the sort well known in the art. Bonescrews 9 comprise the aforementioned head 25 and the aforementionedshank 27.

[0045] Cable restraining washer 12 comprises a body 45 having a bottomsurface 48 (FIG. 3) for engaging the top surface 36 of bone plate 6, adownwardly projecting extension 50 for seating in a recess 40 in boneplate 6, and an upwardly projecting extension 55 for receiving andrestraining at least one cable loop 15.

[0046] Downwardly, projecting extension 50 preferably has asemi-spherical configuration similar to the semi-spherical underside ofa head 25 of a bone screw 9 so as to seat in one of the recesses 40commonly formed in bone plate 6.

[0047] A recess 60 is formed in body 45, in alignment with thedownwardly projecting extension 50 and screw hole 30. Recess 60 is sizedso as to receive the head 25 of a bone screw 9, and screw hole 30 issized so as to receive the shank 27 of a bone screw 9. In this way,cable restraining washer 12 can be mounted to bone plate 6 so that thewasher's downwardly projecting extension 50 seats in a recess 40 formedin bone plate 6, and a bone screw 9 may be passed through the cableretaining washer 12 so that the head 25 of the screw 9 is seated in thewasher's recess 60 and so that the shank 27 of the bone screw 9 passesthrough the washer's screw hole 30, through the screw hole 33 formed inbone plate 6, and into a bone segment 20, 21, whereby to secure thecable retaining washer 12 and bone plate 6 to one another, and to a bonesegment 20, 21.

[0048] Cable restraining washer 12 also comprises the upwardlyprojecting extension 55 for receiving and retaining one or more cableloops 15. More particularly, cable retaining washer 12 also comprises atleast one cable hole 65 extending perpendicular to the axis of thewasher's screw hole 30. Cable hole 65 is sized to slidingly receive acable loop 15. A threaded set screw hole 67 extends downwardly from thetop surface 70 of the washer's upwardly projecting extension 55. Thebottom end of set screw hole 67 intersects the at least one cable hole65 (FIG. 3). A set screw 73 is positioned in set screw hole 67. Setscrew 73 may be tightened down so as to engage a cable loop 15 extendingthrough a cable hole 65, whereby to secure that cable loop to the cableretaining washer 12 and, as a result, to secure that cable loop to abone segment 20, 21.

[0049] Surgical fastening system 5 is intended to be used as follows.

[0050] First, bone plate 6 is positioned against bone segments 20, 21.Then bone screws 9 are used to secure cable retaining washers 12 andbone plate 6 to one another and to bone segments 20, 21. Next, cableloops 15 are passed through cable holes 65 in the cable retainingwashers 12, and then set screws 73 are used to lock cable loops 15 tothe washers.

[0051] Looking next at FIG. 4, there is shown a cable retaining washer112 which comprises an alternative form of the invention. Cableretaining washer 112 is substantially the same as the cable retainingwasher 12 described above, except that it also includes a secondupwardly projecting extension 55, along with that extension's associatedcable holes(s) 65, set screw hole 67, and set screw 73.

[0052] Looking next at FIG. 5, there is shown a cable retaining washer212 which comprises another alternative form of the invention. Cableretaining washer 212 is substantially the same as the cable retainingwasher 12 described above, except that its upwardly projecting extension255 lacks the set screw hole 67 and set screw 73 for locking a cableloop 15 within a cable hole 65. Instead, with cable retaining washer212, upwardly projecting extension 255 is formed so as to be crimpable,whereby to mechanically lock a cable loop 15 within a cable hole 65. Inone preferred form of the invention, upwardly projecting extension 255is formed with a trapezoidal cross-section such as that shown in FIG. 5,whereby to facilitate crimping of the upwardly extending projection 255about the cable.

[0053] Looking next at FIG. 6, there is shown a cable retaining washer312 which comprises another alternative form of the invention. Cableretaining washer 312 is substantially the same as the cable retainingwasher 212 described above, except that it includes a second upwardlyprojecting extension 255.

[0054] Looking next at FIG. 7, there is shown a cable retaining washer412 which comprises another alternative form of the invention. Cableretaining washer 412 is substantially the same as the cable retainingwasher 312 described above, except that each of the upwardly projectingextensions 255 has only one cable hole 65 formed therein.

[0055] In the cable retaining washers 12, 112, 212, 312 and 412described above, the downwardly projecting extension 55 has asemi-spherical configuration so as essentially replicate thesemi-spherical underside of the head 25 of a bone screw 9, whereby itmay be received in the recess 40 formed in bone plate 6. However,forming the downwardly projecting extension 55 with a semi-sphericalconfiguration can sometimes result in the cable retaining washer turningabout the axis of its screw hole 30.

[0056] To guard against this, and looking now at FIGS. 8 and 9, there isshown a bone plate 506 which is provided with an elongated recess 540and a cable retaining washer 512. Cable retaining washer 512 issubstantially the same as the cable retaining washer 212 shown in FIG.5, except that the downwardly projecting extension 50 of cable retainingwasher 212 (FIG. 5) has been replaced with a downwardly projectingextension 550 having a cross-sectional profile matching that of the boneplate's elongated recess 540. If desired, the cable retaining washers12, 112, 312, and 412 may also have their downwardly projectingextensions 50 replaced with similar downwardly projecting extensions550, whereby they can mate securely with recesses 540 of a bone plate506.

[0057] It is also possible to use the cable retaining washers of thepresent invention without a bone plate. In this case, the bone screwpasses through the cable retaining washer and directly into a bonesegment 20, 21. If desired, cable retaining washers 12, 112, 212, 312and/or 412 may be used in this way, with the downwardly projectingextensions bearing against, and generally penetrating into, bone segment20, 21. See, for example, FIG. 10, where cable retaining washer 12 isshown engaging a bone segment 20, 21.

[0058] Alternatively, if desired, the bottom surface of the cableretaining washer can be modified so as to reduce, or entirely remove,the downwardly projecting extension.

[0059] Looking next at FIGS. 11-13, there is shown a suture retainingwasher 612 which comprises another form of the invention. Sutureretaining washer 612 comprises a body 645. Suture retaining washer 612also comprises a downwardly projecting extension 650 for seating in arecess 40 of a bone plate 6 or for engaging the outer surface of a bonesegment 20, 21. Suture retaining washer 612 also comprises at least oneupwardly projecting extension 655 for receiving and retaining at leastone suture loop 615.

[0060] A screw hole 30 is formed in downwardly projecting extension 650and a recess 60 is formed in body 645. Recess 60 is sized to receive thehead 25 of a bone screw 9, and screw hole 30 is sized to receive theshank 27 of bone screw 9. In this way, suture retaining washer 612 canbe mounted to bone plate 6 so that the downwardly projecting extension650 seats in a corresponding recess 40 in bone plate 6, and a bone screw9 may be passed through the suture retaining washer 612 so that the head25 of the screw 9 is seated in the washer's recess 60 and the shank 27of the bone screw 9 passes through the washer's screw hole 30, throughthe screw hole 33 in bone plate 6, and into a bone segment 20, 21,whereby to secure suture retaining washer 612 and bone plate 6 to oneanother, and to a bone segment 20, 21. Alternatively, suture retainingwasher 612 can be mounted directly to a bone segment 20, 21 by seatingdownwardly projecting extension 650 against a bone segment 20, 21, andthen passing a bone screw 9 through the suture retaining washer 612 sothat the head 25 of the screw 9 is seated in the washer's recess 60 andthe shank 27 of the bone screw 9 passes through the washer's screw hole30 and into a bone segment 20, 21.

[0061] Suture retaining washer 612 also comprises at least one upwardlyprojecting extension 655 for receiving and retaining one or more loops615. More particularly, suture retaining washer 612 also comprises atleast one upwardly projecting extension 655, with each upwardlyprojecting extension having at least one suture hole 65 extendingperpendicular to the axis of the washer's screw hole 30. Suture hole 65is sized to slidingly receive a suture loop 615.

[0062] If desired, suture loops 615 can be used to secure soft tissue tobone segments 20, 21. Alternatively, and looking next at FIGS. 14 and15, suture loops 615 can be used to attach a surgical mesh 675 to bonesegments 20, 21.

What is claimed is:
 1. A filament retaining washer for mounting aboutthe shank of a bone screw deployed in a bone whereby to retain thefilament to the bone, said filament retaining washer comprising: astructure having a screw hole extending therethrough for receivingtherein the shank of the bone screw deployed in the bone, whereby tosecure said structure to said bone, said screw hole defining a firstaxis, and said structure having a filament hole extending therethroughfor receiving a filament therein so as to retain said filament to saidstructure, said filament hole defining a second axis extendingsubstantially perpendicular to said first axis.
 2. A filament retainingwasher for mounting about the shank of a bone screw deployed in a bonewhereby to retain the filament to the bone, said filament retainingwasher comprising: a body; a downwardly projecting extension connectedto said body and having a screw hole extending therethrough forreceiving therein the shank of the bone screw deployed in the bone,whereby to secure said downwardly projecting extension to said bone,said screw hole defining a first axis; and an upwardly projectingextension connected to said body and having a filament hole extendingtherethrough for receiving a filament therein so as to retain saidfilament to said upwardly projecting extension, said filament holedefining a second axis extending substantially perpendicular to saidfirst axis.
 3. The filament retaining washer of claim 2 wherein saiddownwardly projecting extension has a semi-spherical configurationsimilar to the semi-spherical underside of the head of the bone screw.4. The filament retaining washer of claim 2 wherein said body forms arecess aligned with said screw hole, said recess receiving the head ofthe bone screw.
 5. The filament retaining washer of claim 2 wherein thefilament is a suture.
 6. The filament retaining washer of claim 2wherein the filament is a cable.
 7. The filament retaining washer ofclaim 6 wherein said upwardly projecting extension is configurable so asto restrain the cable within said filament hole.
 8. The filamentretaining washer of claim 7 wherein said upwardly projecting extensioncontains a set screw hole communicating with said filament hole, and aset screw disposed in said set screw hole for selectively engaging saidcable so as to lock said cable relative to said upwardly projectingextension.
 9. The filament retaining washer of claim 7 wherein saidupwardly projecting extension is crimpable.
 10. The filament retainingwasher of claim 9 wherein said crimpable upwardly projecting extensionhas a trapezoidal cross-section.
 11. The filament retaining washer ofclaim 2 further comprising a second upwardly projecting extensionconnected to said body and having a filament hole extendingtherethrough.
 12. A system for securing an object to a bone, said systemcomprising: a bone screw; a washer comprising: a body; a downwardlyprojecting extension connected to said body and having a screw holeextending therethrough for receiving therein the shank of said bonescrew deployed in the bone, whereby to secure said downwardly projectingextension to said bone, said screw hole defining a first axis; and anupwardly projecting extension connected to said body and having afilament hole extending therethrough, for receiving a filament thereinso as to retain said filament to said upwardly projecting extension,said filament hole defining a second axis extending substantiallyperpendicular to said first axis; and a filament received by saidfilament hole, said filament securing the object to said bone.
 13. Thesystem of claim 12 wherein said downwardly projecting extension has asemi-spherical configuration similar to the semi-spherical underside ofthe head of the bone screw.
 14. The system of claim 12 wherein said bodyforms a recess aligned with said screw hole, said recess receiving thehead of the bone screw.
 15. The system of claim 12 wherein the filamentis a suture.
 16. The system of claim 12 wherein the filament is a cable.17. The system of claim 16 wherein said upwardly projecting extension isconfigurable so as to restrain the cable within said filament hole. 18.The system of claim 17 wherein said upwardly projecting extensioncontains a set screw hole communicating with said filament hole, and aset screw disposed in said set screw hole for selectively engaging saidcable so as to lock said cable relative to said upwardly projectingextension.
 19. The system of claim 17 wherein said upwardly projectingextension is crimpable.
 20. The system of claim 19 wherein saidcrimpable upwardly projecting extension has a trapezoidal cross-section.21. The system of claim 12 further comprising a second upwardlyprojecting extension connected to said body and having a filament holeextending therethrough.
 22. The system of claim 12 further comprising abone plate having a hole extending therethrough, with the shank of saidbone screw passing therethrough, and said filament retaining washerbeing secured about the shank of said bone screw, between said bone andthe head of said bone screw.
 23. The system of claim 12 wherein saidsuture holds a piece of mesh to the bone.
 24. A method for securing anobject to a bone, said method comprising: providing a screw, a filamentand a suture retaining washer, said suture retaining washer comprising:a body; a downwardly projecting extension connected to said body andhaving a screw hole extending therethrough for receiving therein theshank of a bone screw deployed in the bone, whereby to secure saiddownwardly projecting extension to said bone, said screw hole defining afirst axis; and an upwardly projecting extension connected to said bodyand having a filament hole extending therethrough for receiving afilament therein so as to retain said filament to said upwardlyprojecting extension, said filament hole defining a second axisextending substantially perpendicular to said first axis; securing saidwasher to the bone with said screw, with said filament extending throughsaid filament hole; and using said filament to secure the object to thebone.
 25. The method of claim 24 wherein said filament is a cable, andfurther comprising the step of locking said cable to said sutureretaining washer.
 26. The method of claim 24 wherein said filament issuture.
 27. The method of claim 26 wherein said object is a piece ofsoft tissue.
 28. The method of claim 26 wherein said object is a pieceof mesh.
 29. The filament retaining washer of claim 2 wherein saiddownwardly projecting extension is configured to engage a correspondingrecess formed in a bone plate so as to prevent rotation of said filamentretaining washer relative to the bone plate.
 30. The system of claim 12wherein said downwardly projecting extension is configured to engage acorresponding recess formed in a bone plate so as to prevent rotation ofsaid filament retaining washer relative to the bone plate.
 31. Thefilament retaining washer of claim 6 wherein said cable is braidedcable.
 32. The filament retaining washer of claim 6wherein said cable iswire.
 33. The system of claim 16 wherein said cable is braided cable.34. The system of claim 16 wherein said cable is wire.
 35. The method ofclaim 25 wherein said object is bone.
 36. The method of claim 24 whereinsaid washer is secured to said bone so that said washer is countersunkinto the bone.
 37. A method for securing an object to a bone, saidmethod comprising: providing a screw, a filament and a suture retainingwasher, said suture retaining washer comprising: a structure having ascrew hole extending therethrough for receiving therein the shank of thebone screw deployed in the bone, whereby to secure said structure tosaid bone, said screw hole defining a first axis, and said structurehaving a filament hole extending therethrough for receiving a filamenttherein so as to retain said filament to said structure, said filamenthole defining a second axis extending substantially perpendicular tosaid first axis; securing said washer to the bone with said screw, withsaid filament extending through said filament hole; and using saidfilament to secure the object to the bone.